CommercialPrior AuthHigh impact
MPC August 2023
Blue Cross Blue Shield of Nebraska·NE · Ophthalmology, Cardiology, Oral & Maxillofacial Surgery +2 more·Medical Policy
Effective date
Aug 14, 2023
We identified it
Jun 19, 2026
Summary
Blue Cross Blue Shield of Nebraska updated multiple medical policies with new prior authorization requirements and coverage changes. Key changes include new policies for dry eye treatment and several new pharmacy drugs, revised cardiovascular testing policies, expanded sleep apnea surgery coverage, and new hyperbaric oxygen therapy indications.
Action Required
By December 1, 2023: Billing team must update system to require prior authorization for intensive pulse light therapy for dry eyes, cardiovascular risk panels and biomarkers (CPT 83698, 0052U), and maxillofacial surgery for sleep apnea. By September 1, 2023: Add prior authorization requirements for new pharmacy drugs Roctavian, Vyjuvek, Elevidys, Leqembi, and Qalsody. Update encounter forms and notify providers that claims will be denied without proper prior authorization.